CRANIAL/STRUCTURAL THERAPY FOR EFFECTIVE TREATMENT OF HEADACHES Cranial/Structural Soft Tissue Protocols

Transcription

1 CRANIAL/STRUCTURAL THERAPY FOR EFFECTIVE TREATMENT OF HEADACHES Cranial/Structural Soft Tissue Protocols 15 CE Certification Course Integrative Structural Therapy A Division of The Institute of Structural Energetic Therapy, Inc. MM3717 Don McCann, MA, LMT, LMHC, CSETT 156-B Whitaker Road, Lutz, FL Tel: (813) Fax: (813)

2 Integrative Structural Therapy Cranial/Structural Therapy for Effective Treatment of Headaches Cranial/Structural soft tissue protocols Developed by Don McCann, MA, LMT, LMHC, CSETT (MA3267 MH705 MM3717) Copyright 2015 by Don McCann, MA, LMT, LMHC, CSETT All rights reserved. This booklet and material herein is protected by copyright. No part of this booklet or information may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. Published by The Institute of Structural Energetic Therapy, Inc (MM3717) 156-B Whitaker Road, Lutz, FL Ph: , Fax:

3 Cranial/Structural Releases for Headaches 15 CE Certification Course at the 2016 AMTA Rhode Island Massage Therapy Convention By Don McCann, MA, LMT, LMHC, CSETT If you are looking for a way to effectively treat your clients headaches the Cranial/Structural Therapy for Effective Treatment of Headaches, a 15 CE Certification course at the 2016 AMTA Rhode Island Massage Therapy Convention, is a great opportunity for you! In this hands-on workshop you will gain an understanding of the cranial connection to the causes of headache pain, and you will learn Cranial/Structural techniques that can release even some of the most severe and chronic headaches. Seven major causes of headaches, their cranial connection, and their cranial correction will be taught. If you have not been integrating Cranial/Structural therapy with soft tissue therapy when treating your clients headaches you have possibly been missing the most important factors. The structural soft tissue connection of the neck to the cranium will be the first treatment taught. Most tension headaches are because of tension and congestion in the soft tissue in the tops of the shoulders and the back of the neck. This tension also causes a structural imbalance that can run from the neck and shoulders all the way to the pelvis. The release of this tension and the freeing of the cranial motion establish homeostasis and the release of tension related headache pain. These releases will include acupressure points, trigger points, atlas/occipital release, stretching the entire dura, and pumping the cranium via the occiput. The C1 connection to the foramen magnum will then be examined as it puts pressure on the brain stem and locks the occiput, a cause of many major headaches. Headaches from a jamming here are very often chronic and misdiagnosed as severe migraines. When this area is mobilized clients have reported even some of the most severe headaches gone in five minutes, and once this area remains mobile this headache pattern can disappear. It is not at all uncommon for this area to become jammed for clients who have had falls or whiplash injuries. Cranial/Structural soft tissue mobilizations will be taught for C1 to release the pressure on the brain stem and further free up restrictions on the occiput and cranial nerves. With these corrections even the most chronic and severe C1 related headaches are effectively treated. The one sided OM (occipital/mastoid) suture headaches will then be examined and its relationship not only to the cranial motion but also to the compression on cranial nerves reviewed. An OM suture soft tissue release will be taught with special emphasis on restoring the cranial motion of the occiput and the temporal bone. Once released a restricted OM suture will no longer compress cranial nerves or restrict the cranial motion of the occiput and the temporal bones. This will also facilitate the pumping of the Glymphatic system, the principle waste removal system of the brain that pumps cerebral spinal fluid under pressure. An imbalance of the temporal bone rhythm will create headaches and vertigo on the side that is restricted causing the imbalance. This will not only cause a congestion of cerebral spinal fluid around the temporal lobe but also cause compression on cranial nerves, most importantly the trigeminal nerves and trigeminal ganglion. This leads to severe headaches and facial pain. Releasing the restrictions of the temporal bones and synchronizing their rhythm will restore range of motion that will allow congestion of cerebral spinal fluid to pump out reducing pressure, waste products, and inflammatory toxins. In addition it will release soft tissue restrictions that compress on the trigeminal nerve and ganglion relieving pain and inflammation. This also helps relieve pressure and inflammation associated with Bell s palsy. Many TMJ headaches are also related to an imbalance of the rocking of the temporal bones and compression of the trigeminal nerves especially when there has been grinding of the teeth (bruxism). Releasing the restrictions of the temporal bones and bringing them back into balanced rhythm directly affects the nerves associated with TMJ. In addition mobilizing the temporalzygoma relationship brings further balance to the TMJ. This will be integrated with the mobilization of the maxilla which brings a more complete mobilization and integration to the imbalances of the temporal mandibular joint to help relieve TMJ related headaches. Occular migraines, one sided headaches behind the eye, and full one-sided headaches can all be the result of a jamming of the palatine bones. A jammed palatine bone also relates to eye strains and difficulty focusing the eyes. A Cranial/Structural technique that mobilizes the palatines in relationship to the eye socket will take pressure off the optic nerve and reduce pressure in the eye. Additionally mobilizing the palatines in relationship to the ethmoid, vomer, and maxilla will address many other stresses on the facial nerves and bring balance and integration with the facial bones and the cranial motion.

4 A restricted cranial motion often results in a buildup of cerebral spinal fluid and pressure within the cranium and brain. This is often the cause of severe headaches and congestion migraines. A Cranial/Structural technique to facilitate the pumping of the cerebral spinal fluid via the Glymphatic system not only relieves the pressure of a buildup of cerebral spinal fluid, the cause of congestion headaches, but also helps flush out inflammation and toxins from disease, drugs, chemo, and heavy metals, the cause of many headaches. Having these Cranial/Structural tools for the treatment of your clients headaches is going to dramatically increase your effectiveness in getting your clients out of pain. We are looking forward to seeing you in this 15 CE certification class at the 2016 Rhode Island Massage Therapy Convention.

5 Cranial/Structural Therapy for Effective Treatment of Headaches 15 CE Certification Course GENERAL CONTRAINDICATIONS Common sense and what you have been taught as contraindications for massage for the main part apply to all cranial work. Any contraindications that are not listed here should still be adhered to as it is impossible to list all the potential contraindications to massage that can be applicable to cranial work without vastly expanding the length of these training notes. The agreed upon contraindications of massage backed by medical supervision always stand. Listed below are some that might be overlooked or not appear in massage books. Please don t work on children under the age of 13until you have taken an advanced Cranial/Structural class for working with children with Don. blood thinners, (See Attached List, Also Drugs.com) acute conditions such as trauma to head or trunk Concussions: diagnosed written release to normal life activities from MD; undiagnosed 3 weeks without symptoms (muscle test while compressing frontal bone strong=okay to work) acute intracranial hemorrhage recent skull fracture intracranial aneurysm encephalitis, meningitis (active) brain tumors no cranial, can do soft tissue work brain shunts no cranial, can do soft tissue work section of brain protruding through foramen magnum - Chiari detached retina (wait 4 months after surgery & have written release to normal life activities from doctor!) large metal plates across sutures in head Pregnancy between 6-9 months, or at risk pregnancies Recent not fully healed major surgeries (approximately 9 weeks / or written release from MD to normal life activities) Unhealed puncture of dura = cortisone shots, epidurals, etc. Active electrode at base of spine / occiput for Parkinson s disease Wires from appliances going into the cranium Dura not completely healed CAUTIONS metal facial plates (need to see x-rays) facial surgeries (continued)

6 cranial metal plates and screws Cranial/Structural for Headaches Page 2 recent cranial surgeries Severe or prolonged headaches should be evaluated by a physician (could be symptoms of brain tumors or severe pathologies) Recent healed major surgeries Seizures uncontrolled = NO Grand Mal = NO Petite Mal = okay if controlled TESTING FOR ACTIVE CONCUSSIONS Test to determine suitability of Cranial/Structural Frontal/Occipital Decompression: While compressing frontal bone, do the normal muscle testing. If treatment is appropriate, arm will be strong If treatment is not appropriate, arm will be weak. TESTING FOR DEHYDRATION Pull hair on top of head gently do normal muscle testing For a bald head, press lightly just off center on top of head. If client is dehydrated, arm will test weak If client is hydrated, arm will test strong Dehydration can skew the muscle testing.

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8 Cranial/Structural for Headaches Page 4 QUICK RELEASE TECHNIQUE Key factors led to the development of the QUICK RELEASE TECHNIQUE: Cranial / sacral mobilization the need to initiate the release of the reverse curvature of the neck to reduce pain and allow the client to lie more comfortably in a supine position the need for clients to relax before deeper work can be done to address the conditions for which they seek treatment. the ability to provide quick relief from painful symptoms of the head, neck and shoulders, including headaches, when time won t allow for full treatment severely jammed C1 release tension causing stuck cranium prior to CSCDR I or cranial decompression initiate the release of the curvatures of the low back release severe or physical emotional traumas The need for maximizing movement of the occiput in the Craniosacral relationship Create a quick rapport that s positive and supportive YOUR NOTES Clients enter the treatment room with a variety of painful conditions of the head, neck and shoulders as a result of structural imbalances, abnormal curvatures of the cervical spine, whiplash injuries, osteoporosis, and emotional tension, to name a few. They also bring with them day-to-day stresses, anxiety, and the discomfort of acute pain. We know clients need to relax before any deep work can be initiated, but they are often too agitated. The application of the QUICK RELEASE TECHNIQUE (QRT) provides clients with an initial quick release from pain symptoms, as well as initiating the release of the reverse curvature of the neck and curvatures of the low back, both allowing the client to feel more relaxed. This is true even with clients presenting with extremely abnormal curvatures from osteoporosis. QRT helps build confidence in the effectiveness of the treatment and the competence of the therapist. It also helps create a trusting relationship through a touch that is firm, supportive, and comforting. From this relationship clients can then view other deep work in the same vein, not as intrusive therapy. APPLICATION OF THE QUICK RELEASE TECHNIQUE The quick release sequence is composed of trigger points, acupressure points, and modified craniosacral therapy, and is most effective when applied in the numerical sequence presented here. Acupressure energies flow in specific directions through the meridians, and energy transfers from one meridian to another. By working in this sequence there is a logical energetic flow based on theories found in acupressure. The trigger point releases reduce pain referrals moving from the outside in toward the cervical spine which softens the holding pattern of the thoracic and shoulders allowing for the additional release of the trigger points directly under the edge of the occiput and mastoid process with the modified A/O release (C1 / Occiput). The diaphragms throughout the body are released.

9 To increase effectiveness of the QRT, the massage therapist needs to: be comfortable - not create problems within their own bodies be conscious of maintaining correct structural alignment be relaxed, breathing easily, to create a relaxed and safe atmosphere Cranial/Structural for Headaches Page 5 Positioning client in supine position - top of head even with head of table MT sitting or kneeling at head of client client head supported only in extreme cases, and only until some of the trigger points have been released allowing the client to lie supine more comfortably without the support (use of this support maintains the reverse curvature you are trying to release) To treat the points, the MT will: prop fingertips upward from the table into the point client s body weight will supply the necessary downward pressure use bunched fingers - at least 1 finger will be on the point (the finger position can be adjusted for more accurate pressure into the point as the point softens) keep fingers hooked to avoid hyperextending them support fingers with back of hand resting on table hold the point for 30 seconds minimum, don t lift up, body sinks in - usually 1-2 minutes is adequate unless doing extended treatment concentrate on SINK IN, SINK IN, SINK IN, SINK IN while holding point Stimulation of points will result in significant changes such as: A point that is hot temperature-wise will have significant cooling A point that is cool temperature-wise will show significant increase in warmth or heat A point surrounded by hardened, full tissue will significantly soften A point that is very active with pulsing will quiet and calm down A point that is swollen will pump until the swelling is palpably reduced A point that is quiet may pump, pulse, quiver, vibrate, or twitch and then quiet again A point that feels full of energy, like an electrical current, will quiet down A point that feels devoid of energy will energize (feel like electricity runs through it), and then quiet, but not to the point of no energy A point and its surrounding muscle will have movements that become quite active, then become quiet (unwind) Points on each side can have different sensations During stimulation of a point: a client s body will get heavier a client will relax and overall body softens breathing may become rapid or ragged, then regular and relaxed a client s body or head, neck, and shoulders may become flushed, then normalize a client may become agitated, then relaxed a client may seem not to breathe, then have a relaxed, fuller breathing (these are the most common - there are other responses not listed) Initially, it is better to spend more time on a point to learn to feel all the possible changes - this will more effectively accomplish the goals of QRT

10 PLEASE NOTE: client s relaxation will flow into you making you feel very relaxed if the client isn t breathing, check your own breathing - 90% of the time you will be holding your breath relaxation, safety, and regular energy flow is communicated to client when you concentrate on your own breathing With profound relaxation of client, make sure your head is not directly over client s head - waking your client with your head directly contacting the client s head can be embarrassing, as can your snoring - both of these have occurred! TREATMENT GOALS Application of QRT will initiate: release of headaches Occipital mobilization Sacral mobilization Dura mobilization Diaphragm mobilization release of A/O (atlas/occipital) jam release of ischemia, inflammation, swelling, spasmed tissue and pain unwinding of structural imbalances by the lengthening of soft tissue through the top of the shoulder, posterior neck, and upper thoracic reduction in reverse curvature of the neck mobilization of the neck/shoulder relationship release of shoulder shrug mobilization of energy through the acupressure meridians which reduces pain in the muscles they pass through - posterior / medial / anterior neck, jaw, and tissues of cranium vault mobilization of blocked emotional energy & stress locked in the tissue increase range of motion via mobilization of energy and reduction of tightening in soft tissue blocking the energy lengthening & mobilization of soft tissue affected by the meridian resulting in reduction of reverse curvature & releasing jaw clenching & distortions of spine unwinding of bunched holding pattern in the rhomboids and juncture of scapula, thoracic and cervical vertebrae increased rotation of head due to lengthening of tissues in suboccipital area decrease in pain of thoracic outlet syndrome decrease in pain in neck and low back After the Quick Release Technique clients are usually very relaxed, in less pain, and can comfortably lie in a supine position on the table without support for the reverse curvature of the neck. This will now allow the massage therapist to address the other major specific causes of the reverse curvature, and the additional painful conditions in the head, neck, and shoulder or low back. Cranial/Structural for Headaches Page 6

11 Cranial/Structural for Headaches Page 7 QUICK RELEASE TECHNIQUE Diagram of Points This technique is used for the relief of headaches, neck pain and tension; preparation for deeper work; and to assist the client in letting the head rest more comfortably on the table. The trigger points are held with fingertip pressure until a significant release is felt: i.e. softening of tissues, heat release at the point, hard throbbing to a lighter throbbing, fingertips sinking into the tissues, or any combination. Often a significant release is felt within 3 minutes. Client supine - MT seated at head of table - arms resting on table with elbows at 45 degree angle Hold point #1 on both sides using fingertips of both hands. Hold until a significant release is felt and fingers sink in. Move to point #2 - hold for release, and so on... At point #5 place tips of all fingers (bent) of both hands together along the base of the cranium - sink in and hold with slight traction, and then follow the softening and releasing with both hands moving slowly and laterally moving only as the tissue softens and releases (don t force the motion) along the base of the occiput to the mastoid processes. When this area is released and your fingers have reached the mastoid process, gently traction and release the occiput several times moving with the cranial motion to lengthen the dura and free the cranial/sacral mechanism. This also pumps the cerebral spinal fluid up and down the spine from the brain to the sacrum. NOTE: You CAN do the Quick Release Technique on children age 7 and older.

12 Cranial/Structural for Headaches Page 8 MUSCLE TESTING PROCEDURE (Client supine, hands to side, legs straight. Use client s RIGHT arm) Have client raise right arm about 60 degrees rotate arm internally, thumb pointing down toward table Using your right hand, have client resist your downward pressure to measure strong arm strength (direction of pressure is down toward table approximately 5 below armpit, not toward pelvis or feet) Place middle finger of your left hand just above bridge of nose on suture of frontal and nasal bones, and have client resist (not muscle up) your downward pressure to measure weakened arm strength (arm should test weak), and to see if client is testable (If client is muscling or recruiting other muscles, have client increase internal rotation of the arm with thumb pointed down toward table and test again. Make sure client is not pushing UP against you as you press down client resists without pushing up as you press down.) Repeat 2&3 several times if necessary to have both client and therapist comfortable with difference between weak and strong feel. ************************************************* C1 Headaches A jammed C1 causes compression on the brain stem Chronic headaches Tension headaches Cluster headaches Migraine headaches Kinesiology evaluation fingertips press along bicipital groove on each arm muscle test (both sides will test weak if jammed) Correction Sit at head of table Place thumbs of both hands on transverse processes of C1 - thru SCM just behind angle of jaw Gently rock back and forth until restricted soft tissue releases and both sides move freely - usually feels jammed on one side initially After the soft tissue restriction releases, press firmly down with both thumbs simultaneously 3 times to finalize the soft tissue release ************************************************** OM Suture Headaches (OM = Occipital / Mastoid) A Jammed OM suture: Chronic headaches Migraine headaches Cluster headaches Kinesiology evaluation Using fingertips press on mastoid process muscle test (will test weak if restricted)

13 Cranial/Structural for Headaches Page 9 Correction (1) Right OM (Occipital / Mastoid) Suture release left hand under occiput right hand fingers along mastoid process parallel to ear distract occiput from mastoid process OM Suture (2) Left OM (Occipital / Mastoid) Suture Release Right hand under occiput fingers on occiput Left hand fingers along mastoid process Parallel to ear Distract occiput from mastoid process Releasing OM Suture **************************************************************** Temporal Bone Restriction Headaches Restricted temporal bone Trigeminal Nerve Trigeminal Neuralgia Vertigo Kinesiology evaluation Press on Mastoid process with fingertips muscle test (will test weak if restricted) Correction Alternating & Synchronizing rocking of temporal bones Both hands under occiput with fingers interlaced, thumbs positioned on mastoid processes. Alternating rocking one thumb at a time: gently press diagonally in and down one side at a time, alternating from side to side; when pressing with one thumb, release the other. NOTE: if motion is sluggish, pull ear --- outward and diagonally back O base of skull Synchronized rocking both thumbs simultaneously: gently press diagonally in/down - release - press release follow cranial rhythm. NOTE: Always follow --- Alternating Rocking with Synchronized Rocking. O base of skull

14 Palatine Headaches Cranial/Structural for Headaches Page 10 Restricted Palatine Behind the eye One sided headaches: Kinesiology evaluation Hand over one eye at a time muscle test (eye on side of restriction will test weak, correct weak side first) Correction Place finger cot on index finger - release weak side first, then the other side as shown below. (always correct both sides) USE VERY LIGHT PRESSURE! Roll outward NOTE: once you release the Palatines, you will need to do the following corrections: PPM = Pterygoid/Palatine/Maxilla: Place index on the gum above front teeth, lift up like a fish hook toward ceiling, hold for release EVM = Ethmoid-Vomer-Maxilla: 1. Place tip of thumb of upper hand under bony bump at base of nose, place thumb and index finger of other hand next to nostrils above eye teeth, distract by lifting up with thumb at base of nose, and pull toward feet with hand above eye teeth hold for release. 2. Then without moving hands continue to lift up on base of nose and change direction of pressure with bottom hand pressing down toward table hold for release that feels like the maxilla drops down. (#2 press down toward table hold for release as described above. #1 - Pull toward feet as shown above. Kinesiology to confirm release of all above: Palatine cover and muscle test each eye both should be strong PPM lightly place bent finger between nose and lip, muscle test should test strong EVM place thumb and index finger of upper hand just above eye teeth and gently push toward feet, muscle test should test strong.

15 Congestion Headaches Headaches caused by congestion in the brain Migraines Chronic Treating the Glymphatic and Lymphatic system in the brain Cranial/Structural for Headaches Page 11 REASONS TO APPLY FRONTAL/OCCIPITAL DECOMPRESSION After detached retina issues wait 4-6 months! Detoxing the brain heavy metals, anesthesia, elderly on many medications, etc. Swelling within the cranium Concussions non-diagnosed = min 3 weeks, diagnosed = Dr. release to normal life activities Post-surgery detoxing anesthesia Sinus and inner ear swelling tinnitus (if calcification, no. if just pressure, yes). Eustachian tube release. Chemotherapy (clear chemo fog) just before treatment, not within 4 days after treatment. Prevention and treatment of Alzheimer s Transition out of this life Learning disabilities, ADHD Autism, Asperger s Concentration challenges Right / Left brain integration Emotional shock / distress Post-traumatic stress disorder Chakra balancing Diaphragm balancing cranial colonic Focusing and eye problems Re-establish homeostasis of the brain TIA s (mini strokes) Nervous system disorders i.e. Parkinson s, ALS, etc. Brain damage issues i.e. electro shock therapy, etc. Alzheimer s / Dementia Lymphatic balancing and clearing Lymphedema Tics - facial Minor seizures (petite mall and smaller) (Continued)

16 Down s syndrome Fluid build-up in brain for elderly Vertigo, brain fog, etc Glaucoma Difficulty Sleeping Immune System Cranial/Structural for Headaches Page 12 Remember for Concussions: Undiagnosed possible concussion No treatment until client is 3 weeks without symptoms. Headaches can be symptoms of concussion, OR are most likely from a jammed C1 from a blow to the head. Diagnosed concussions At least 3 weeks without symptoms Have doctor s written release to resume normal life activities For long term slow recovery from concussions, make sure you have a written release from the doctor stating that there is no more damage of hemorrhaging or possibility of blood clots. Kinesiology evaluation for congestion and swelling in the brain Place palm of hand gently on center of frontal bone, fingers pointing to top of head Compress frontal bone with gentle pressure and muscle test will test weak if swelling or congestion Correction Apply Frontal/Occipital Decompression following the sequence in the Frontal/Occipital Decompression below ****************************************************************************************** Cranial/Structural Frontal/Occipital Decompression 1. QUICK RELEASE have client use restroom first Protocol 2. FRONTAL/OCCIPITAL DECOMPRESSION SEQUENCE FRONTAL / OCCIPITAL DECOMPRESSION One hand cradling the occiput with fingers pointing down towards feet Other hand resting on the frontal bone with the fingers pointing towards feet and middle finger and ring finger separated by nose Center of palms over 3 rd eye and EOP on Occiput. Gently compress the cranium, slowly compressing with light pressure until the cranial motion stops. Hold for approximately 30 seconds.

17 Cranial/Structural for Headaches Page 13 After the 30 seconds of compression when you feel the cranium pushing back at you, start rocking motion encouraging the cranial motion (Flexion/Extension) while continuing the same compression pressure on the cranium. Encourage the rocking motion until it moves freely and smoothly. Both hands are moving in the same directions Flexion / Extension. Very gradually let your top hand release a small amount of compression and rock at that level until it is moving freely and smoothly (do a minimum of 7 sets of Flexion/Extension at each level), and then move up a tiny bit to the next level and rock there until it is moving freely and smoothly (again, a minimum of 7 sets of Flexion/Extension). Continue this procedure gradually lessening the compression for at least seven (7) levels while in constant contact with the cranium. Very gradually ease out of the energy field once you have broken contact with the cranium. This may take anywhere from 10 minutes to as much as an hour - average is about 30 minutes. FRONTAL LIFT Place hands by head and thumbs pointing up. Gently contact frontal bone with thumbs by eye on the frontal bone and gently lift frontal bone toward the ceiling. This is a very gradual lift and lifts the frontal bone from the sphenoid and parietals. Hold for 30 seconds, then slowly release it back and break contact. PARIETAL DECOMPRESSION (Sagittal Suture Release) Hands along the side of head with fingers above the temporal bones on the parietals have client clench jaw to make sure you are above the temporalis muscle. Thumbs crossing the sagittal suture. Starting just behind the coronal suture gently lift parietals towards the top of the head lifting the parietals off the temporal bones while applying gentle spreading pressure on the thumbs opening the sagittal suture. Move thumbs incrementally posteriorly lifting the parietals / spreading the sagittal suture until the entire sagittal suture has been decompressed. Use very gentle pressure. SLEEP SUTURE RELEASE Just off to the right of center on the coronal suture, place one thumb on the frontal bone and the other on the parietal bone gently distract the two thumbs away from each other releasing about 1 of the coronal suture. That is the sleep spot.

18 Cranial/Structural for Headaches Page 14 TEMPORAL DECOMPRESSION Interlocked fingers supporting the occiput and thumbs resting on the mastoid processes of the temporal bones. (See explanation on page 5 for Rocking & Synchronizing Temporal Bones) Using your thumbs very gently rock the temporal bones one at a time by applying diagonal pressure, in and down, alternating from side to side. This is done very slowly and gently. With each rocking hold one mastoid process with constant pressure to allow decompression, while releasing pressure on the other one. Repeat on other side. Alternate back and forth at least 7-10 times. Pay attention to the difference between the range of motion of the two temporal bones and continue until they are balanced in the range of motion. Synchronize the temporal bones by very gently pressing diagonally in and down on both mastoid processes simultaneously, and then releasing them simultaneously, at least 7-10 times. Pay attention to the rocking and coordinate with the cranial rhythm. Your rhythm should match the cranial rhythm. TEMPORAL EAR PULL Hold ear lobes with thumb and index finger. Gently pull ears outward on the same diagonal plane as the petrous ridges of the temporal bones a 45 angle out and back toward the table. Hold approximately ten seconds. Gently release and allow ears to return to natural position. Give the client time to slowly become present. Muscle test and release the following if they test weak: (refer to page 7 for testing and releasing) Palatines PPM Ethmoid-Vomer-Maxilla Remember: if you correct Palatines, automatically correct PPM, EVM If you correct PPM, automatically correct EVM Muscle test all to confirm release should all test strong

19 Cranial/Structural for Headaches Page 15 CONTACT US We are here to support you. If you have any questions or concerns, please take advantage of this support and contact us. Every question is important! is much preferred because we can respond more quickly. Playing phone tag takes more time and can be frustrating. If you text, PLEASE IDENTIFY YOURSELF! Pam Putnam Direct line: (number to text identify yourself please) SET Office: Don McCann YouTube: Search TheSet2go Websites: Facebook Like us on: Be Friends with Don on: